​Lessons Learned from Global and Local Initiatives
May 2021

Laura Powis, MPH, AMCHP, Evidence & Implementation Team, Global Health Workgroup  


As we have seen time and time again throughout this pandemic, vaccine hesitancy is an ever-evolving concern. Just when vaccination numbers are on the rise, an event like the recent temporary pause of the Johnson & Johnson’s COVID-19 vaccine can shake people’s confidence and trust. Given this type of reaction, it is critical that public health professionals understand the roots of vaccine hesitancy and their role in building vaccine trust.   

To explore this topic, AMCHP’s Global Health Initiative held a webinar on April 16, 2021, titled “Earning Trust, Building Vaccine Confidence: Lessons Learned from Global and Local Initiatives,” which featured presentations from Dr. Bruce Gellin, President of Global Immunization at the Sabin Vaccine Institute; Cecelia Thomas, Senior Government Relations Manager at Trust for America’s Health; and Dr. Anne Zink, Chief Medical Officer of the State of Alaska. The webinar explored successful global and local efforts at building vaccine confidence, looked deeply at vaccine hesitancy’s history and relationship with access, and explained the importance of meaningful partnerships and power sharing to build trust.   

Check out the recording of the full event here and read below a modified excerpt from the event Q&A. 

What messaging strategies can public health professionals take to combat vaccine hesitancy in response to the J&J vaccine pause and to address hesitancy in general?   

Dr. Gellin: Full transparency is key. If you don’t know the answer, tell people what you know, what you’re doing to address the issue, what that means for them, and how they should factor existing information into decisions. Let them know you will give an update once you know more. 

Dr. Zink: I would 100 percent echo that. Medicine has moved to this idea of shared decision-making over time. We’ve seen the power of data visualization in this too. People have many ways to access information. We in public health need to make sure we’re not just making reports for the sake of making reports. We need to be sharing information in a way that empowers individuals to make healthy decisions for themselves. This means providing information that’s easily accessible.  

In Alaska, we have various press conferences and events to make sure we have a two-way conversation with the Alaska public to answer their questions. Creating space and time for them to ask individual questions is what we have found to be the most valued and biggest change in building confidence overall.  

Ms. Thomas: Making this message accessible to community leaders is key. You have to have a trusted messenger speaking with language that makes sense to a given community. Not everybody is in policy and not everybody is a scientist. Most of us are not. So, if you speak to women of reproductive age and compare vaccine risks to birth control risks that helps put the risk in context with something they are likely familiar with. Facts and figures can make people’s eyes glaze over, so we want to speak in terms that make sense to actual people.

As a home visitor, we are hearing a lot of hesitancy among pregnant and breastfeeding women. How should we message to this group? 

Dr. Zink: Our home visiting program has been challenged with [hesitancy from this group], and we’re actually using [home visitors] to increase vaccine access. That means [we are] giving them the resources and tools to have that conversation because they’re already a trusted messenger in those homes. We’re also working with our WIC program, primary care providers, OB-GYNs, and pediatricians to help message this. So, again, that trusted messenger is key in this space. 

Also [we need to recognize] what is known and unknown, and as Cecilia mentioned, [we need to share] information in a way that’s relatable. I honestly find saying that I myself was super excited for my 16-year-old to get vaccinated, and I wouldn’t have asked her to do that if I was concerned about fertility issues has helped earn trust. Similarly, one of our clinicians who was pregnant shared her experience with getting vaccinated. Sharing her personal story in combination with the data really personalized it for people.  

Dr. Gellin: This concern is something we have seen in the whole field of maternal immunization, including influenza and pertussis. It’s not that the vaccine is “getting to” the baby, but the mother is essentially becoming the factory of antibodies that protects the baby through a process we call passive immunization. 

Ms. Thomas: We must recognize that the information we receive changes weekly if not daily. Let folks know this is the current information we have. Be honest about the fact that these are preliminary results and that things have been overwhelmingly positive. 

How can we combat the fact that vaccine confidence has become a political issue?  

Ms. Thomas: Across the political spectrum, we’re all people with people in our lives that we trust. We’re always so caught up on racial and political differences. But at the end of the day, you need people you trust, who look like you, to let you know that this is okay. 

Dr. Zink: As Bruce mentioned, words matter. There was an excellent presentation from the de Beaumont Foundation [that talks] about words and vaccine hesitancy. Understanding that some groups of people are more concerned about side effects of the vaccine than COVID itself really helped our messaging as we shifted our communications to address these concerns. Choosing words that resonate with specific communities as well as trusted leaders make a huge difference.   

How do we as public health professionals combat the speed at which misinformation about vaccines spreads? Whose responsibility is it to counter anti-vaccination messaging?  

Ms. Thomas: The vaccine advocates I’ve worked with stress the importance of not repeating the misinformation in your own communications. Because a lot of misinformation is “flashy” and entertaining, people are going to remember the myth over the fact if compared side-by-side. Also, make sure to discuss facts in a way that is relatable. Instead of just sending someone to the CDC website, first relate the information to a person’s experience. You can also direct folks to advocacy websites that may have more family-friendly and accessible language.